Introduction to Electromyography and Nerve Conduction Testing, ed 2.

Echternach JL. Thorofare, NJ 08086, Slack Inc, 2003, paperback, 194 pp, illus, ISBN: 1-55642-529-5, $28.95.

This combination textbook and laboratory manual began as a continuing education manual and has evolved over Dr Echternach's 30 years of teaching electrophysiologic testing. The primary purpose of the book is to provide a concise overview of this specialized area of physical therapist practice and to allow beginning physical therapists the opportunity to comprehend the "essence" of the electrophysiologic techniques. The material is targeted principally at physical therapist students, but it also would be very useful for a clinician who is beginning the process of skill acquisition in this area.

The text begins with a brief introduction to the equipment and electrodes used in electrophysiologic testing, followed by a laboratory exercise. The laboratory exercise illustrates skin impedance, background noise interference with biologic potentials, and other technical errors that are encountered in routine recordings. The next 2 chapters address basic nerve conduction testing (both motor and sensory) and needle electromyography. Each chapter is followed by several laboratory exercises, case histories, and review questions. A summary of late responses or second waves (chapter 4) follows the chapter on electromyography; again, laboratory exercises and review questions follow the presentation of the late responses.

The next chapter provides the essential components of a "routine" electrophysiologic examination for patients with various musculoskeletal or neurologic disorders as well as for patients with suspected primary myopathies. Neither the suggested testing procedures nor the rationale for the test are explained in this chapter. For example, the author states that, when testing for suspected carpal tunnel syndrome, sensory nerve conduction to digits 2 and 3 should be performed--but he does not offer a reason for this decision. The last chapter deals with more advanced electrophysiologic testing techniques, such as repetitive stimulation studies for neuromuscular junction defects, and less commonly performed nerve conduction studies, such as studies of the long thoracic nerve. This chapter is mostly a "teaser" chapter, intended to inform the reader that there is a large world beyond the basics to be explored. The text ends with a suggested reading list, 4 appendixes, and an extremely useful index. Two of the appendixes contain definitions of terms used in electrophysiology, one presents the principles of universal precautions, and the last gives a suggested report format for the results of testing.

The most useful aspect of this text is the laboratory exercises. These exercises are explained in sufficient detail that most students could complete the laboratory in a self-study format, with little or no oversight by the instructor. The case histories are somewhat simple, but they do provide enough information for students to begin to grasp the complexity of the topic and understand how electrophysiologic testing can enhance physical therapist practice and patient management. The book is organized in a logical manner, and it is written in a very sparse style, which is perfectly appropriate for this type of book. There are many line illustrations, which strongly reinforce the written material.

Overall, Dr Echternach has accomplished his stated purpose. This short text will provide any student with the essence of electrophysiologic testing. As stated by the author, this text is not a stand-alone text. It provides little information regarding pathology and it does not give a detailed explanation of the process of conducting a full examination, but these areas were not the focus of the book. Clinicians with even limited experience in this area of practice probably will not find this text useful, but the book will be an invaluable resource for instructors and students.

Frank B Underwood, PT, PhD, ECS 

University of Evansville

Evansville, Ind

Dr Underwood is Professor in the Physical Therapy Department and conducts electrophysiologic testing in an outpatient practice.